Glue ear, grommets, and adenoids - East Kent Hospitals University

Glue ear, grommets, and adenoids
Information for patients from Head and Neck
You have been diagnosed as having a problem with fluid or mucus build-up behind the ear drum.
This is often referred to as “glue ear”. This leaflet is to explain possible treatments that may be
offered to you if the condition persists.
The Normal ear and hearing
The normal ear is divided into three parts - outer, middle, and inner ear.
Ear Bones
Air
Wax
Ear Drum
Eustachian Tube
Adenoids
The outer ear funnels sound waves in air to the ear drum which forms the boundary between the
outer and middle ear. The ear drum vibrates when sounds arrive. The vibrations are transmitted to
the inner ear via three small bones (ossicles) suspended in the middle ear.
The inner ear acts like a microphone, turning sound vibrations into electrical signals which are
sent to the brain via the nerve of the hearing. The inner ear is also concerned with balance. To
hear normally, the eardrum and ossicles must be able to move easily. For this to occur the middle
ear must contain air at the same atmospheric pressure as the outer ear. The air in the middle
comes from the back of the nose via the Eustachian tube.
What is glue ear?
Glue ear is a build-up of fluid behind the eardrum in the middle ear. The fluid may be thick and
sticky or thin and watery. Either way, it stops the eardrum and ossicles vibrating easily so quieter
sounds are not heard. Glue ear is the commonest cause of deafness in children. Other names for
glue ear are middle ear effusion and chronic secretory otitis media.
Ear Bones
Glue
Wax
Ear Drum
Eustachian Tube
Blocked
Adenoids
Often Enlarged
What causes glue ear?
Most children get glue ear after a cold or ear infection. The Eustachian tube is small and blocks
easily (see diagram above). It then fails to ventilate the middle ear. Sticky secretions can not drain
away so fluids build up in the middle ear. Movement of the ear drum and ossicles is impaired,
causing partial deafness. Most cases get better quickly after a cold resolves. A minority persist for
months or years.
Large adenoids at the back of the nose and passive smoking are the most common reasons
for glue ear to persist. Sometimes glue ear runs in families, although it is not, strictly speaking,
hereditary. Often, no particular cause is found.
What are adenoids?
Adenoids are cauliflower-like swellings of immune tissue at the back of the nose. Normal adenoids
help fight off infections. If they get too big they cause blockage of the nose and Eustachian tube. In
severe cases they can cause obstruction of breathing at night.
What are the symptoms of glue ear?
• Deafness of mild to moderate degree is the commonest symptom. It often varies from week-to week, being worse after a cold.
• If deafness occurs early in childhood, speech may be delayed. Unclear speech and constant
shouting are common.
• Later, education may be affected. Sometimes deafness is not suspected but the child is thought
to be inattentive, slow, or lazy, Concentration may be poor. The child often seems to be ‘in a
world of his/her own’.
• Some sufferers get frequent earaches.
• There may be repeated ear infections with high temperature.
• Poor balance and clumsiness may feature.
• Older children often complain of noises in the ears.
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What is the treatment?
The fluid frequently goes away by itself so a policy of watch and wait may be best. By the age
of eight years many children have ‘grown out of it’, though this is only the average. Some will
carry on having trouble into their teens. Any exacerbating factors should be eliminated, especially
passive smoking (inhaling smoke of other peoples’ cigarettes/cigars).
Antibiotics and painkillers, for example Calpol, can be used for ear infections. Decongestants, for
example Sudafed, are often prescribed but have not proven effective.
Glue ear can be seasonal, worse in the winter and better in the summer, so any decision to
operate may be deferred if the child is seen in the spring. An operation is more likely to be
recommended in the autumn. The decision to operate is always individual, based on all the
factors in that particular case. For immediate relief, myringotomy and grommets insertion is highly
effective. Removal of the adenoids may be recommended if the adenoids are enlarged and where
glue ear recurs after initial grommet insertion.
What is a grommet and how does it work?
A grommet is a tiny plastic tube, shaped like a mini cotton reel, about 2mm across. It is fitted
through a small cut in the eardrum (myringotomy). The tension of the eardrum grips the grommet.
The cotton reel shape prevents it falling in or out.
Ear Bones
Air
Wax
Grommet in
Eustachian Tube
place through
Ear Drum
Adenoids
The grommet allows air from the outer ear directly into the middle ear. Provided the grommet
remains in position and is not blocked, the hearing returns to normal almost immediately. The
grommet does not drain fluid out - it lets air into the middle ear.
It is designed to stay in position for about nine to 15 months. Then the eardrum heals over and
the grommet drops out. It is important to understand that a grommet does not cure the underlying
cause of glue ear. It does provide highly effective and immediate relief of deafness and earaches
while it is in position and working. This buys time and allows normal education. Meanwhile the
child has a chance to ‘grow out of it’. If adverse factors, for example passive smoking, are not
dealt with, there is an increased risk that the glue ear will come back once the grommets fall out.
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How is the operation done?
Grommet insertion is a quick and simple day case procedure. It is very delicate and normally done
under anaesthetic (patient fully asleep). The anaesthetic is usually given by injection into a vein
in the back of the hand. To prevent the needle from hurting, a local anaesthetic cream is usually
applied beforehand. A microscope provides a magnified view of the eardrum. A small cut is made
in the eardrum and the fluid in the middle ear is sucked out. The grommet is inserted and some
ear drops applied.
If the adenoids are to be removed, this is normally done under the same anaesthetic and they are
removed via the mouth. No external cut is needed.
What happens after the operation?
Children recover very rapidly from grommet insertion and should be able to return to school after
a day or two. The hearing normally improves immediately but do not worry if there is still some
difficulty in the first weeks as it can take time in some cases.
There may be a very slight earache, treated easily with Calpol (Paracetamol). There may be slight
bleeding from the ear in the first few days. This is normal and nothing to worry about.
After an adenoidectomy your child may be uncomfortable for up to a week and have a sore throat,
which can be treated with Paracetamol. Your child should stay off school for seven to 10 days
and should avoid contact with anyone who has a cold or other infection as there is a small risk of
heavy bleeding from the nose. If this occurs, you should telephone the hospital and/or attend the
nearest Accident and Emergency department (A&E).
What about swimming and grommets?
No swimming for the first two weeks. After that, surface swimming is allowed without earplugs. If
your child wishes to dive or use waterchutes, some well-fitting silicone rubber earplugs should be
worn. Bath water is much worse than swimming pool water because it contains germs from the
rest of the body and irritant soap. Bath water should not be allowed in the ears. The head should
not be submerged in the bath. For hair washing, either use earplugs or a piece of cotton wool
rubbed with vaseline to provide a waterproof seal.
When cleaning the ears gently clean only the outer part of the ears and never use cotton buds.
Does fluid discharge from the ear?
In the first few days after the operation, there may be a slight discharge or bleeding from the ear.
This is normal and nothing to worry about. After that, there should be no discharge. If the ear runs
persistently and is especially smelly, that means an ear infection.
The infection is best treated with ‘antibiotic with steroid ear drops’, such as Sofradex or Gentisone
HC (these can be prescribed by your GP). These must be inserted correctly with the patient lying
on one side with the affected ear uppermost. The discharge should be mopped away gently. The
drops must get right into the ear canal. You then massage the tragus (the piece of skin that sticks
out just in front of the ear canal like an open trapdoor) to force the drops through the grommet
into the middle ear. It is rather like plunging a blocked sink. The infection should clear up within a
few days. Antibiotics taken by mouth are not very good in treating ear infections where there is a
grommet present.
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What happens after the grommet comes out?
The grommet only helps while it is in the eardrum and open. After it has fallen out, the eardrum
heals over. In two out of three cases, the hearing remains normal, there is no further build-up of
fluid and the condition is cured. If the Eustachian tube is still blocked, the glue ear can recur and
it may be necessary to operate again in one in three cases. Of patients who have a second set of
grommets, about one in three will require a third (one in nine overall) and, of those, one in three
will require a fourth set (one in 227 overall) and so on.
Will a follow-up appointment be necesssary?
Do grommets scar the eardrum?
Yes. But the scar does not have any noticeable effect on hearing. It is less of a problem than the
scarring caused by repeated ear infections.
Contact details
If you have any queries or concerns please contact one of the following.
• Day Surgery Centre, Kent and Canterbury Hosptial
Telephone: 01227 783114
• Channel Day Surgery, William Harvey Hospital, Ashford Telephone: 01233 616263
• Day Surgery Centre, Queen Elizabeth the Queen Mother Hospital, Margate
Telephone: 01843 234458
• Padua Ward, William Harvey Hospital, Ashford
Telephone: 01233 651855
• Dolphin Ward, Kent and Canterbury Hospital, Canterbury Telephone: 01227 864052
Further information
If you have any further queries or concerns, please speak to your doctor or consultant.
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Any complaints, comments, concerns, or compliments
If you have other concerns please talk to your doctor or nurse. Alternatively please contact our
Patient Advice and Liaison Service (PALS) on 01227 783145 or 01227 864314,
or email ekh-tr.pals@nhs.net
Further patient information leaflets
In addition to this leaflet, East Kent Hospitals has a wide range of other patient information leaflets
covering conditions, services, and clinical procedures carried out by the Trust. For a full listing
please go to www.ekhuft.nhs.uk/patientinformation or contact a member of staff.
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This leaflet has been produced with and for patients
Information produced by Head and Neck
Date reviewed: June 2015
Next review date: June 2017
CSP/EKH014